Of sex and science. Elizabeth Pisani's blog about HIV and other sundry things.

17/02/10

As promised, data on women, autonomy, partnerships and HIV. It’s quite true that I have not developed some magic indicator of “autonomy”. But the World Economic Forum has. Or at least its Gender Equality Index is as close as damnit. Let’s take the sub-Saharan African countries at either extreme, and set their equality index against their HIV rates:

On individual measures that are often indicators of women’s ability to make their own choices and decisions — educational level, for example, we see a strong correlation too, both at the national level:

and at the household level:

So, in countries where women are more equal to men on measures of workforce and political participation as well as education, there’s more HIV than in countries where women are more constrained. In countries where women are more educated, there’s more HIV. Within countries, more educated women are more likely to be infected with HIV.

Multiple concurrent partnerships: we’re crap at defining them, and therefore at measuring them. The imporant issue is simply: how likely is an infected person to be having sex with an uninfected person in the relatively short periods when viral load is high? These periods are more frequent where other STIs (and especially HSV2) are high. But the highest viraemia is right after someone first becomes infected. So anyone who has several partners in the two of three month window in which they themselves were infected are most likely to pass on the virus to others. If enough people (men AND women — it has to work on both sides of the equation in a heterosexual epidemic) have multiple partners in that time, you have the potential for a hyper-epidmic. Without it, you don’t.

Here are data from the first round of national surveys of HIV-related risk, way back in 1989-1991. The dark bars are people who reported that they had more than one REGULAR partner in the previous year. I.e. more than one person to whom they were married and with whom they had been having sex on an ongoing basis for a year or more. You can see that there’s something of a difference between countries in Africa and those elsewhere.

For your interest, I’ve also put in what people think their partners do. In almost every case, men report fewer partners than their wives think they have. I.e., women think men are pigs. And women report more partners than their husbands think they have. Men labour under the illusion that women are angels.

women aren’t angels, they’re victims of (black, obviously) males’ risky sex and drug-injecting behaviors who need to be saved (but the men don’t need saving, b/c they are the problem). By the way, have you read this article? It’s in the current issue of AJPH: Higgins et al. Rethinking Gender, Heterosexual Men, and Women’s
Vulnerability to HIV/AIDS. Am J Public Health. 2010;100:
435–445 http://ajph.aphapublications.org/cgi/reprint/100/3/435

The link between HIV rates and gender equality is tenuous at best.
There is always more promiscuity in rich urban areas than poor rural ones, likewise in rich nations rather than in poor ones….
Infection rates have nothing to do with the fact women are better educated and better paid in the rich nations, but that men in rich nations are more likely to be urbanised, have more money to throw around in bars and clubs, there is more of a culture of drunkeness and by default prostitutes, and men can afford more “girlfriends”.

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Wisdom of Whores is Elizabeth Pisani's blog and personal site. For her professional site please visit